PATENT COOPERATION TREATY PCT REQUEST FOR INDICATION OF AVAILABILITY FOR LICENSING PURPOSES Applicant's or agent's file reference International filing date (day/month/year) Priority date (day/month/year) International application No. Applicant 1. The applicant hereby requests the International Bureau to indicate the availability for licensing purposes of the invention(s) claimed in this international application on the PATENTSCOPE website. 2. Licensing terms (optional): The applicant is willing to license the claimed invention(s): in: all PCT Contracting States all PCT Contracting States except (indicate each State by its two-letter code): ______________________________ ______________________________________________________________________________________________ the following State(s) only (indicate each State by its two-letter code): ____________________________________ ______________________________________________________________________________________________ for exclusive use by the licensee for non-exclusive use by the licensee 3. Additional licensing terms (optional) (if the space below is insufficient, please use the Annex to this form): 4. Licensing contact: Any person interested in a licensing agreement for the invention(s) claimed in this international application should contact the following person: 5. Signature of applicant(s), agent or common representative: Name: Form PCT/IB/382 (January 2012) Capacity: Date: American LegalNet, Inc. www.FormsWorkFlow.com International application No. ANNEX TO FORM PCT/IB/382 Continuation of item 3 (If this Annex is not used, this sheet should not be included in this request): Form PCT/IB/382 (Annex) (January 2012) American LegalNet, Inc. www.FormsWorkFlow.com